Diagnosing wound infection is a clinical judgement. Micro-organisms are contained in all wounds however the majority do not become infected.

An increased level of suspicion for the likelihood of wound infection should be maintained in patients with:

• Diabetes Mellitus
• Autoimmune disease
• Hypoxia/poor tissue perfusion
• Immunosuppression

Wound management strategies must aim to provide optimal wound healing conditions:

• Antibiotic use should be limited to specific clinical situations (e.g. overt infections) and directed to susceptible organisms
• Prescribing of antibiotics should adhere to employing organisations policies and local Joint Formularies. Doses need to be of a therapeutic level and for sufficient duration
• Wound status must be regularly reviewed, and management strategies changed when progress towards healing is not achieved

Topical antibiotic preparations are used to reduce levels of bacteria within the wound bed and in burns to prevent infection. They are frequent sensitisers, can encourage the development of resistant bacteria and have no effect on healing. Therefore, their use should be carefully restricted.

Please see 13.10.1 Antibacterial preparations

Swabs

Wound swabs should be taken following wound cleansing (and debridement if appropriate) from wounds which are critically colonised or clinically infected. The following wound types should be swabbed:

• Acute wounds with signs of infection
• Chronic wounds with signs of spreading or systemic infection
• Critically colonised/locally infected wounds that have not responded to or are deteriorating despite appropriate topical antimicrobial treatment

The swab result is to confirm that the antibiotic regime is the appropriate one. If indicated, change antibiotics in response to swab.

For suspected critically colonised wounds a two-week anti-microbial dressing challenge without microbiological swabbing is appropriate.

Systemic antibiotics should be used in the presence of systemic and spreading infection.

Antibiotics should be prescribed in line with local antibiotic prescribing policies. A swab should also be sent, and antibiotic changed if indicated by result.

Anti-microbial dressings

Anti-microbial dressings should be considered to reduce bio burden in acute and chronic wounds that are infected or are being prevented from healing by microorganisms.

Please see 17.3 Antimicrobial dressings